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NPI Code Detail

MEDICARE: MICHAEL WISE

MEDICARE: MICHAEL WISE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1922267210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WISE
Provider Business Mailing Address
First Line : 125 N LAKE ST
Second Line :
City : MANISTIQUE
State : MI
Zip : 49854-1234
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 114 W ELLIOTT ST
Second Line :
City : SAINT IGNACE
State : MI
Zip : 49781-1868
Country : US
Telephone Number : 906-643-8616
Fax Number : 906-643-7194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2008
Last Update Date : 06/03/2008

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Directions to “ MICHAEL WISE ” Practice Location

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